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Y6 Senior Med COPY > Endo 2 > Flashcards

Endo 2 Flashcards

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1
Q

What are causes of low Mg

A

LOW INTAKE: TPN, alcoholic, malnutrition

RENAL LOSS: diuretics (loop, thiazide), metabolic disorders (Gitelman, Bartter), nephrotoxic drugs (amphotericin B, aminoglyocosides)

GI LOSS: diarrhoea

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2
Q

what metabolic abnormalities does hypomagnaesemia often occur with

A

low potassium

low calcium

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3
Q

when must you suspect hypomagnaesemia

A

when the patient has:

  • refractory hypokalaemia
  • unexplained hypocalcaemia
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4
Q

sx hypomagnaesemia

A 
nausea, anorexia, voomiting 
parasthhesia 
seizures 
tetany 
arrythmias
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5
Q

how do you manage hypomagnaesemia

A

> 0.4: magnesium salts, orally

<0.4: IV MgSO4 40mmol /24h

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6
Q

what causes acromegaly

A

a pituitary adenoma producing excess GH

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7
Q

sx of acromegaly

A

headachhes
soft tissue swelling (enlarged hands and feet)
prognathism (protruding jaw)
macrocossia

cx: HTN, DM

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8
Q

ix of acromegaly

A

IGF1 raised

OGTT > GH raised

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9
Q

what is normal calcium rnage

A

2.2 to 2.6

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10
Q

what causes release of PTH

A

low dietary calcium or low sunlight > cause low serum calcium

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11
Q

what does PTH do to phosphate

A

gets rid of it (PHOSPHATE TRASHING HORMONE)

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12
Q

what are the roles of activated vit D

A

increase intestinal calcium absorption
increase intestinal phosphate absorption
bone formation

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13
Q

summarise osteomalacia in one sentence

A

normal bone density but ABNORMAL bone structure (weak and demineralised bone)

disorder of mineralisation of bone matrix (osteoid).

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14
Q

what is the principal cause of osteomalacia

A

Vit D deficiency

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15
Q

what are RF / co-morbidities that lead to osteomalacia

A

RF: dark skin, lack of sunlight, dietary deficiency, malabsorption

Co-morb:
- Decreased 1a-hydroxylation of vitamin D to calcitrol: chronic kidney disease and hypoparathyroidism
- Decreased 25-hydroxylation of vitamin D: liver disease, anticonvulsants

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16
Q

what is osteomalacia in children called

A

rickets

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17
Q

sx of osteomalacia

A

bone pain and tenderness –> fractures
proximal myopathy –> waddling gait
weakness
malaise

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18
Q

sx of rickets

A

bow legs
costochondral swelling
myopathy
hypotonia
short stature

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19
Q

explain what happens to hormones and electrolytes in osteomalacia (starting from the low vit D)

A

low vit D > less calcium absorbed > raised PTH > raised bone resorption (so raised ALP) >

normal/ low calcium with BRITTLE bone

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20
Q

radiograph of osteomalacia

A
  • May appear normal or show osteopenia
  • Looser’s zones = wide, transverse lucencies, usually at right angles to the involved cortex (AKA pseudofractures)
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21
Q

what kind of hyperparathyroidism occurs in osteomalacia

A

SECONDARY hyperparathyroidism (vit d def)

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22
Q

summarise osteoporosis in one sentence

A

low bone density

normal bone structure

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23
Q

primary and secondary causes of osteoporosis

A

Primary
- age related decline
- post-menopausal

secondary
- malignancy (myeloma, metastatic carcinoma)
- endocrine (cushing’s, hyperthyroid, hypogonadism)
- drugs (steroids, heparin)
- rheumatological (rheumatoid arthritis, ankylosing spondylitis)

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24
Q

risk factors for osteoporosis

A
  • old age
  • low BMI
  • low calcium intake
  • smoking and alcohol abuse
  • lack of exercise
  • late menarche and early menopause
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25
sx of osteoporosis
asymptomatic | until pathological fracture occurs
26
Characteristic fractures in osteoporosis
- **Neck of femur** (after minimal trauma) - **Vertebral fractures** (leading to loss of height, stooped posture and acute back pain on lifting) - **Colles' fracture** (of the distal radius after falling on an outstretched hand)
27
signs of osteoporosis
Often NO SIGNS until complications develop: - **Tenderness on percussion** (over vertebral fractures) - **Thoracic kyphosis** (due to multiple vertebral fractures) - Severe pain when **hip flexed and externally rotated** (suggests NOF fracture)
28
how do you ix osteoporosis
**Bloods: NORMAL** in primary osteoporosis (Calcium, Phosphate, ALP) - If **vitamin D low**, may indicate **osteomalacia** **DEXA Scan** (T score** < -2.5** = osteoporosis) **FRAX tool**: estimate 10 year fracture risk **X-Ray** wrist, heel, spine, hip: Used to diagnose fractures
29
what does a T score between -2.5 and -1 indicate
osteopenia
30
treatment for osteomalacia
**Vitamin D and calcium replacement** – if dietary deficient - In malabsorption/hepatic disease: give vit D2 (**ergocalciferol**) - In renal disease or vitamin D resistance: give **alfacalcidiol** (1a-hydroxyvitD3) or **calcitriol** (1,25-dihydroxyvitD3) * Treat the underlying CAUSE
31
how do you manage osteoporosis
lifestyle: - **stop smoking, reduce alcohol, weight bearing and muscle-strengthening exercise** medical: - **Vit D / calcium supplements** - Anti-resorptive agents: *inhibit bone resorption*: **biphosphonate (alendronate = 1st line, Risedronate 2nd line**) , deosumab (anti RANKL) , **Raloxifen = 3rd line** - Agents that *increase bone formation* : **Teriparatide** - Dual action agents: **Strontium = 3rd line, Romosozumab** - **HRT**
32
complications of bisphosphonate treatment
jaw necrosis
33
what first question must you ask when you see a HIGH calcium
is PTH HIGH or LOW
34
cuases of LOW CA, LOW PTH
surgical (post thyroidectomy) | autoimmune
35
how do you trreat low calcium
calcium + vit D supplements if Ca <1.9: calcium gluconate
36
explain the negative effects of CKD on calcium and phosphatye
Kidneys usually allow activation of vit D > CKD causes low calcium Kidneys usually excrete PO > CKD causes excess PO
37
how do you manage low calcium, high phosphate in CKD
1. Reduce dietary PO 2. Use phosphate binders (e.g. aluminium based binder, sevelamar) 3. Vit D supplement (alfacalcidiol, calcitrio) 4. consider parathyroidectomy
38
what is the MAIN CAUSE of primary hyperaldosteronism
1. BILATERAL ADRENAL HYPERPLASIAA (up to 70% of cases)
39
what are the two causes of primary hyperaldosteronism
1. bilat adrenal hyperplasia | 2. adrenal adenoma (Conn's)
40
How do you distinguish between bilat adrenal hyperplasia and adrenal adenoma (Conn's)
HR-CT abdo and adrenal vein sampling
41
how do you manage a bilat adrenal hyperplasia
aldosterone antagonist (e.g. spironolactone)
42
how do you manage an adrenal adenoma in Conns
surgery (removes the tumour but leaves some adrenal gland, so the patient does not become addisonian)
43
when must levothyroxine be given if co-administered with iron / calcium supplements
at least 4 hours before or after
44
how do you manage hypothyroidism in pregnancy
increase dose by up to 50% in first 4-6 weeks of pregnancy
45
how do you give hydrocortisone in addisons
twice daily | the largesst dose in the morning, second dose after lunch
46
how many units (of insulin) ae there in 1ml
100
47
what do glucocortcoids do to WBC and neutrophil count?
WBC decreases | but neutrophils increase initially
48
whaat is the MOA of MODY
Autosomal DOMINANT
49
how do you manage thyroid cancer
THYROIDECTOMY (hemi or total) + IODINE 131 (to kill all remaining cells) yearly followup > if positive, administer more I-131
50
when can you discharge someone with thyroid cance r
if in remission for 7 years
51
what is the effect of heparins on potassium
increase potassium as they inhibit aldosterone
52
what is the effect of tacrolimus on potassium
reduce K+ excretion> increase potassium
53
what is the effect of NSAIDS on the kidney
they inhibit reniin release
54
HYPERKALAEMIA on ECG
``` tall tented T wave Broad QRS flat P wave Prolonged PRR interval Sine wave > cardiac arrest ```
55
do pituitary adenomas always have to secrete hormones?
NO - they could be NON FUNCTING PITUITARY ADENOMAS they would present with hypopituitarism and pressure effects (headache)
56
what kind of breathing occurs in DKA
KUSSMAUL breathing - excess CO2 is exhaled to try to compensate for metabolic acidosis
57
what diabetics need to be followed up by the local foot centre
ALL DIABETICS who have any foot condition other than CALLUSES
58
what is thyroid acropatchy
TRIAD OF - nail clubbing - tissue swelling of the hands and feet - new bone formation
59
what is Nelsons syndrome
removal of the adrenal glands > pituitary enlargement > hypopituitarism from compressing the stalk and RAISED ACTH (hyperpigmentation)
60
What test can help distinguish between T1DM and T2DM
C peptide -- will be LOW in T1 (because low insulin production) but RAISED in T2 (due to high insulin production, but insensitivity of cells)
61
how does HYPOThyroidism affect periods
HYPOthyroidism causes MENORRHAGIA
62
How does HYPERthyroidism affect perodos
causes AMENORRHHOEA
63
HbA1c target for T1 DM
48
64
most common cause of hypopituitarism
non-secretory pituitary macroadenoma
65
othre causes of hypopituitarism
* ischaemia: **sheehan's syndrome, pituitary apoplexy** * infiltration: **haemochromatosis, sarcoidosis** * hypothalamic tumours e.g. **craniopharyngioma** * trauma * iatrogenic irradiation
66
presentation of o Pituitary apoplexy
thunderclap headache + xanthrochromia + vomiting + LOC
67
what is Paget’s Disease of Bone
increased bone turnover --> **excessive bone remodelling**, **bone enlargement, deformity and weakness**
68
symptoms of pagets disease of the bone
May be ASYMPTOMATIC May present with **insidious onset deep BONE PAIN** ->aggravated by **weight bearing and movement** = Usually due to **microfractures** **Headaches** **Sensorineual Deafness** (due to compression of vestibulocochlear nerve) **Fractures** **Deformities**: *frontal bossing, prognathism, bone bowing, inc skull size, spinal kyphosis*
69
paget's disease of the bone investigations
Bloods: **raised ALP, normal Ca and PO4** X RAY: - **Osteoporosis circumscripta** = well defined osteolytic lesions that appear less dense compared with normal bone - **Cotton wool appearance of the skull** = poorly defined patchy areas of increased density (sclerosis) and decreased density (lysis) **Tc99m**: lesions show inc uptake
70
management of pagets disese of the bone
Conservative - Monitor indefinitely due to risk of osteosarcoma - walking sticks if problems walking Medical - Pain management: NSAIDs, paracetamol - Bisphosphonates e.g. zoledronate (**Monitor serial ALP** and give **Vit d and calcium supplements** ) Surgical - If bone deformity / pathological fractures / nerve compression - Give bisphosphonates pre-op
71
complications of pagets disease
deafness osteosarcoma spinal stenosis spinal cord compression

Y6 Senior Med COPY (29 decks)

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